MEDICARE: JOSE TRINIDAD URIBE RDHAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	937	CA

General Provider Information

NPI Number	:	1356206767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE TRINIDAD URIBE RDHAP

Provider Business Mailing Address
First Line	:	3908 W 110TH ST
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90303-2128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3575 CAHUENGA BLVD W STE 300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-1342
Country	:	US
Telephone Number	:	818-980-1200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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